The Accumulated Effects of Foam Rolling Combined with Stretching on Range of Motion and Physical Performance: A Systematic Review and Meta-Analysis
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©Journal of Sports Science and Medicine (2021) 20, 535-545 http://www.jssm.org DOI: https://doi.org/10.52082/jssm.2021.535 ` Review article The Accumulated Effects of Foam Rolling Combined with Stretching on Range of Motion and Physical Performance: A Systematic Review and Meta-Analysis Andreas Konrad 1, Masatoshi Nakamura 2, Daniel Bernsteiner 1 and Markus Tilp 1 1 Institute of Human Movement Science, Sport and Health, Graz University, Austria 2 Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan shorter stretching durations (
536 Combined effects of foam rolling and stretching (including all techniques) to that of stretching or foam roll- of the references (search through the reference list) and ci- ing alone on both ROM and physical performance. A fur- tations (search through Google Scholar) of the nine already ther goal was to distinguish between the effects of the included papers, three more papers were identified as being stretching technique (static stretching, dynamic stretching), relevant. Therefore, in total, 12 papers were included in this the type of foam rolling (vibration foam rolling, non-vibra- systematic review and were used for the meta-analysis. The tion foam rolling), the tested muscles (hamstrings, quadri- whole search process is depicted in Figure 1. ceps, triceps surae, hip, shoulder), and the order of the com- bined treatment (either foam rolling followed by stretch- Inclusion and exclusion criteria ing, or vice versa) by the use of a subgroup analysis. This review considered studies that compared the com- bined effects of an acute bout of both stretching and foam Methods rolling on ROM and/or performance parameters (e.g., strength, jump height) to the effects of foam rolling or This review was conducted according to the PRISMA stretching alone in healthy participants. We included stud- guidelines and the suggestions from Moher et al. (2009) for ies in the English, German, and Japanese languages with systematic reviews with meta-analysis. crossover (pre- to post-comparison or post-comparison) or parallel group (pre- to post-comparison) designs. However, Search strategy we excluded conference papers and theses. An electronic literature search was performed in PubMed, Scopus, and Web of Science. The search period ranged from 1990 until the 15th February 2021. The keywords for Extraction of the data the online search were (“foam rolling” OR “self-myofas- From the included papers, the characteristics of the partic- cial release” OR “roller massage” OR “foam roller”) AND ipants, the sample size, the study design, the characteristics (stretch*), and they were the same for all the databases. The of the intervention (e.g., stretching technique, vibration systematic search was done by three independent research- foam rolling vs. non-vibration foam rolling, duration), and ers (AK, MN, DB). In the first step, all the hits were the results of the main variables (ROM and/or performance screened by their abstract. If the content of a study re- parameters) were extracted. For the main variables, either mained unclear, the full text was screened to identify the the pre- and post-values (plus standard deviations) or the relevant papers. Following this independent screening pro- post-values (plus standard deviations) of the combined cess, the researchers compared their findings. Disagree- groups (stretching plus foam rolling) and the single inter- ments were resolved by jointly reassessing the studies vention groups (foam rolling or stretching, but also from against the eligibility criteria. Overall, 169 papers were the control group,) were extracted. If the required data were screened, from which nine papers were found to be eligible missing, the authors of the studies were contacted via for this review. However, following the additional search email. Figure 1. PRISMA flowchart.
Konrad 537 Statistics and data synthesis In total, 12 studies compared the effects of a combined treatment (foam rolling plus The meta-analysis was performed using Comprehensive Meta-Analysis software, accord- stretching or stretching plus foam rolling) with the effects of stretching or foam rolling ing to the recommendations of Borenstein et al. (2009). By the use of a random-effect alone on ROM. Within these 12 studies, seven studies compared the effects of a combined meta-analysis, we assessed the effect size of the ROM in terms of the standardized mean treatment with stretching on performance parameters. Overall, 17 effect sizes could be difference between the combined effects (foam rolling and stretching together) and extracted for the ROM parameters and 24 for the performance parameters. In summary, stretching alone, between the combined effects and foam rolling alone, and between the combined effects and a control condition. Due to the smaller number of available studies 267 participants (143 males and 124 females) with a mean age of 22.9 (±5.1 years) partic- for the performance parameters and the restriction that a minimum of three studies was ipated in the included studies. Out of the 267 participants 141 were athletes, 76 were phys- necessary to perform a meta-analysis, we could only assess the effect size of the combined ically active, and six were sedentary. The activity level of the remaining 44 was not de- effects, compared to stretching alone. Moreover, by using a mixed-effect model, we per- fined. Table 1 presents the characteristics and outcomes of the 12 studies. formed subgroup analyses with the stretching technique (static stretching, dynamic stretching), the type of foam rolling (vibration foam rolling, non-vibration foam rolling), Risk of bias assessment and methodological quality the tested muscles (hamstrings, quadriceps, triceps surae, hip, shoulder), and the order of The Egger’s regression intercept test indicated that no reporting bias was likely for the the combined treatment (either foam rolling followed by stretching or stretching followed meta-analysis dealing with ROM and for the comparison of the combined treatment with by foam rolling) in both the analyses of the ROM and performance parameters. In addition, stretching (intercept -0.59; P = 0.31), foam rolling (intercept 0.78; P = 0.81), or the control for the performance parameters, we also performed a subgroup analysis for the type of condition (intercept 0.32; P = 0.91). When comparing the effect on performance parame- task (strength, jump height, sprinting). A minimum of two effect sizes per subgroup was ters between the combined treatment and stretching alone, the Egger’s regression intercept necessary to perform a subgroup analysis. To determine if there were differences between test indicated a potential for reporting bias (intercept -1.51; P = 0.00). The average PEDro the effect sizes of the subgroups, Q-statistics were applied (Borenstein et al., 2009). Ac- score value is 6.92 (±1.31), indicating a low risk of bias (Maher et al., 2003; Moran et al., cording to the recommendations of Hopkins et al. (2009), we defined the effects for a 2021). The two assessors agreed for 125 out of the 132 criteria (12 studies × 11 scores). standardized mean difference of 4.0 as triv- The mismatched outcomes were discussed and the assessors finally agreed on the scores ial, small, moderate, large, very large, and extremely large, respectively. I2 statistics were presented in Table 2. calculated to assess the heterogeneity among the included studies, and thresholds of 25%, 50%, and 75% were defined as having a low, moderate, and high level of heterogeneity, Range of Motion respectively (Behm et al., 2021b; Higgins et al., 2003). An alpha level of 0.05 was defined Combined stretching/foam rolling vs. stretching alone for the statistical significance of all the tests The meta-analysis with 17 effect sizes from 12 studies revealed no significant difference in ROM changes between the combined condition and the stretching condition alone (ES Bias assessment and methodological quality = 0.032; Z = 0.517; CI (95%) -0.090 to 0.155; P = 0.61; I2 = 0.00) (see Figure 2). Fourteen The methodological quality of the included studies was assessed using the PEDro scale. out of the 17 effect sizes allowed us to calculate pre- to post-changes. The remaining three In total, 11 methodological issues were assessed by two independent researchers (AK, effect sizes were based on post-values only. The combined condition and the stretching MN) and assigned with either one or no point. Hence, studies with a higher score represent condition alone (pre- to post-comparison) showed an average increase in ROM of 6.83% higher methodological quality. If any conflict between the ratings of the two researchers (CI (95%) -0.34% to 14.00%) and 5.26% (CI (95%) -1.59% to 12.10%), respectively. was found, the methodological issues were reassessed and discussed. Moreover, the Eg- None of the subgroup analyses, including the stretching technique (static stretching, ger’s regression intercept test was applied to detect possible publication bias. dynamic stretching) (Q = 0.01; P = 0.92), the type of foam rolling (vibration foam rolling, non-vibration foam rolling) (Q = 0.05; P = 0.83), and the order of the combined treatment Results (Q = 0.66; P = 0.42), revealed significant differences in ROM. However, we did not perform a subgroup analysis with the tested muscles, since there were subgroups with only Results of the search one effect size.
538 Combined effects of foam rolling and stretching Table 1. Characteristics of the included studies (n = 12). Treatment Outcome Study Name Participants Foam rolling Stretching Combined Range of motion Performance N = 29; 8 male and 21 Dynamic stretching 20 min: Dynamic 3 x 30 s/MTU: gluteals, female (23 physically ac- movements of as large ROM as Foam rolling + Smith, et al., 2018 hamstrings, quadriceps, Sit and reach Vertical jump height (cm) tive/6 sedentary) (age 22 ± 3 possible targeting gluteals, hamstrings, dynamic stretching and calf years) quadriceps, and calf 20 s/MTU with vibration: N = 40; 25 male and Dynamic stretching: 8 dynamic Dynamic stretching quadriceps, hamstrings, Knee flexion CMJ height (cm) Lin et al., 2020 15 female college badminton movements of the trunk + upper and + vibration foam calf, rotator cuff, lower Knee extension Agility (s) players (age 21.4 ± 1.5 years) lower extremities rolling back N = 12; 12 male softball Static stretching: 3 x 30 s per stretch: Glenohumeral 2 x 60 s/MTU: Foam rolling + Fairall et al., 2017 players (age 36.92 ± 11.17 sleeper stretch internal rotation - infraspinatus static stretching years) and cross-body stretch ROM 30 s/MTU: hip flexors and quadriceps, adduc- Squat jump height (cm) N = 14; 14 female tors, Dynamic stretching: For 5 min; CMJ height (cm) Richman et al., Foam rolling + (8 volleyball, 6 basketball) tensor fasciae latae and participants performed their own rou- Sit and reach Drop jump height (cm) 2019 dynamic stretching players (age 19.8 ± 1.3 years) gluteus, hamstrings, plan- tine Agility T-Test (s) tar flexors, and dorsiflex- Short sprint (s) ors N = 11; 6 male and 5 female Škarabot et al., Static stretching: 3 x 30 s plantar Foam rolling + swimmers (age 15.3 ± 1.0 3 x 30 s plantar flexors Dorsiflexion ROM - 2015 flexors static stretching years) CMJ height (inches) Hip flexion active N = 12; 7 male and 5 female 30 s/MTU: Static stretching Hurdle jump height (inches) Hodgson et al., Static stretching: 2 x 30 s/MTU Hip flexion passive recreationally trained athletes hamstrings and quadri- (30 s/MTU) + foam Hurdle jump contact time (s) 2019 hamstrings and quadriceps Knee flexion active (age range 18-30 years) ceps rolling (30 s/MTU) Knee flexion peak torque (Nm) Knee flexion passive Knee extension peak torque(Nm) N = 24 male soccer players; 30 s/MTU: 11 in the control group (age quadriceps, Static stretching: 10 s/MTU Kyranoudis et al., Foam rolling + CMJ height (cm) 21.7 ± 1.1 years); 13 in the hamstrings, quadriceps, hamstrings, Hip flexion ROM 2019 static stretching CMJ free height (cm) experimental group (age 21.6 adductors, adductors, gastrocnemius ± 0.7 years). gastrocnemius Dynamic stretching: 4 x 15 repetitions Hamstring strength 60°/s (Nm) 4 x 30 s/MTU Dynamic stretching Che Hsiu et al., N = 10; 10 female handball (5 x slow and 10 x as fast as possible) Knee extension Hamstring strength 240°/s (Nm) with vibration: quadriceps + vibration foam 2021 players (age 21 ± 1 years) targeting the quadriceps and hamstring Knee flexion Quadriceps strength 60°/s (Nm) and hamstrings rolling muscles Quadriceps strength 240°/s (Nm) N = 18; 18 female Dynamic stretching: 60 s dynamic Foam rolling + Cunha et al., 2021 recreationally trained athletes 60 s hamstrings movements targeting the hamstring Straight leg raise - dynamic stretching (age 24.0 ± 2.0 years) muscles
Konrad 539 Table 1. Continues… Treatment Outcome Study Name Participants Foam rolling Stretching Combined Range of motion Performance N = 44; 26 male (age 21.7 ± 1.7 years) and 18 female Foam rolling + Smith et al., 2019 athletes (age 21.3 ± 2.0 3 x 30 s calf Static stretching: 3 x 30 s calf Ankle dorsiflexion - static stretching years); activity level not reported 30 s/MTU: Dynamic stretching: dynamic Vertical jump height (cm) thoracic/lumbar N = 11; 11 male physically movements of the whole body Standing long jump (cm) spine, gluteal, ham- Foam rolling + Peacock et al., 2014 active individuals (age 22.2 either Sit and reach 18.3 m pro agility (s) Indirect 1-RM string, dynamic stretching ± 2.2 years) performed as 2 x 10 bench press (kg) calf, pectoral, repetitions or 2 x 10 m 37 m sprint (s) quadriceps N = 42; 24 male and 18 Dynamic stretching: 60 s in female physical therapy Foam rolling + Somers et al., 2020 60 s calf downward dog targeting the Ankle dorsiflexion - students (age 26.1 ± 4.0 dynamic stretching posterior chain years) Table 2. PEDro scale of the included studies; * = was not counted for the final score; 1 = one point awarded; 0 = no point awarded. Inclusion Random Concealed Similarity Subject Therapist Assessor >85% Intention to Between-group Point estimates Total criteria allocation allocation at baseline blinding blinding blinding follow-up treat analysis comparison and variability Smith et al., 2018 1 1 0 1 0 0 0 1 1 1 1 6 Lin et al., 2020 1 1 0 1 0 0 0 1 1 1 1 6 Fairall et al., 2017 1 1 0 1 0 0 0 1 1 1 1 6 Richman et al., 2019 1 1 0 1 0 0 0 1 1 1 1 6 Škarabot et al., 2015 1 1 1 1 0 0 0 1 1 1 1 7 Hodgson et al., 2019 1 1 1 1 0 0 0 1 1 1 1 7 Kyranoudis et al., 2019 1 1 0 1 0 0 0 1 1 1 1 6 Che Hsiu et al., 2021 1 1 0 1 0 0 0 1 1 1 1 6 Somers et al., 2020 1 1 1 1 0 1 1 1 1 1 1 9 Smith et al., 2019 1 1 1 1 0 1 1 1 1 1 1 9 Peacock et al., 2014 1 1 0 1 0 0 0 1 1 1 1 6 Cunha et al., 2021 1 1 1 1 0 1 1 1 1 1 1 9
540 Combined effects of foam rolling and stretching Figure 2. Forest plot presenting the combined effects compared to stretching on range of motion. (Std diff in means = stand- ardized difference in means; CI = confidence interval). Figure 3. Forest plot presenting the combined effects compared to foam rolling on range of motion. (Std diff in means = stand- ardized difference in means; CI = confidence interval; FR= foam rolling). Combined stretching/foam rolling vs. foam rolling foam rolling studies and studies where stretching was fol- alone lowed by foam rolling were part of this meta-analysis. The meta-analysis with six effect sizes from six studies re- However, we did not perform a subgroup analysis with the vealed no significant difference in ROM changes when the tested muscles since there were subgroups with only one combined condition was compared to the foam rolling con- effect size. dition alone (ES = -0.225; Z = -1.182; CI (95%) -0.597 to 0.148; p = 0.24; I2 = 62.89) (see Figure 3). The combined Combined stretching/foam rolling vs. control condition condition and foam rolling condition alone (pre- to post- The meta-analysis with six effect sizes from three studies comparison) showed an average increase in ROM of revealed a significantly higher increase of a small magni- 13.77% (CI (95%) -0.61% to 28.16%) and 7.19% (CI tude in ROM in the combined condition compared to the (95%) 2.48% to 11.89%), respectively. control condition without any intervention (ES = -0.332; Z The subgroup analyses differentiating between dif- = -2.499; CI (95%) -0.593 to -0.072; p = 0.012; I2 = 32.38) ferent stretching techniques revealed no significant differ- (see Figure 4). The six effect sizes of the combined condi- ence in ROM (Q = 0.58; p = 0.45). A subgroup analysis tion and the control condition (pre- to post-comparison) including the type of foam rolling or the order of the com- showed an average change of 1.51% (CI (95%) -4.74% to bined treatment was not possible since only non-vibration 7.76%) and 0.21% (CI (95%) -1.16% to 1.59%), respect- Received: 18 June 2021 / Accepted: 21 June 2021 / Published (online): 01 July 2021
Konrad et al. 541 tively. The subgroup analyses of the stretching technique one effect size. (Q = 0.78; p = 0.38), the tested muscles (Q = 1.44; p = 0.49), and the order of the combined treatment (Q = 0.78; Discussion p = 0.38) revealed no significant difference in ROM The purpose of this review was to compare the effects of changes. A subgroup analysis with the type of foam rolling an acute bout of a combined treatment of stretching and was not possible since only non-vibration foam rolling foam rolling to the effects of stretching or foam rolling studies were part of this meta-analysis. alone on both ROM and performance parameters in healthy subjects. For ROM, the meta-analysis revealed the superior Performance effect of a combined treatment compared to the control A meta-analysis of the effects on performance was only condition (no stretching or foam rolling); however, no su- possible with the combined condition and the stretching perior effect was found for the combined treatment com- condition alone since there were insufficient studies and pared to either stretching or foam rolling alone. In addition, effect sizes for the foam rolling condition available. further subgroup analyses of ROM (e.g., stretching tech- The meta-analysis with 24 effect sizes from seven nique, muscle groups tested) showed no differences be- studies revealed no significant difference in performance tween the modalities. With regard to performance, the parameters between the combined condition and the meta-analysis revealed no difference between the com- stretching condition alone (ES = -0.029; Z = -0.503; CI bined treatment compared to stretching or foam rolling (95%) -0.142 to 0.084; p = 0.62; I2 = 0.00) (see Figure 5). alone; however, the subgroup analysis of performance re- Ten out of the 24 effect sizes allowed us to calculate pre- vealed the trivial but superior effect of the combined treat- to post-changes. The remaining 14 effect sizes were based ment compared to stretching alone, but only if the foam on post-values only. The combined condition and stretch- rolling was followed by stretching. ing condition alone (pre- to post-comparison) showed Three meta-analyses were performed for ROM. Thereby, changes in performance of -0.41% (CI (95%) -3.02% to the combined effects (stretching and foam rolling) were 2.19%) and -0.07% (CI (95%) -3.34% to 3.22%), respec- compared to a control condition, stretching alone, and foam tively. rolling alone. The combined treatment had a superior effect By comparing the order of the combined treatment on ROM compared to the control condition. Increases in (either foam rolling followed by stretching or vice versa), ROM following a single stretching (Behm et al., 2016; the subgroup analysis revealed a significant difference be- Behm et al., 2021a; Behm and Chaouachi, 2011) or foam tween the subgroups of “foam rolling followed by stretch- rolling treatment (Wilke et al., 2020) were reported by sev- ing vs. stretching alone” and “stretching followed by foam eral studies. However, it is not clear if the increases in rolling vs. stretching alone” (Q = 5.53; p = 0.02). While ROM have an accumulated effect when foam rolling and stretching followed by foam rolling showed a similar mag- stretching are performed within one training session, com- nitude of change as stretching alone (ES = 0.10; p = 0.21), pared to foam rolling or stretching alone. Anderson et al. the foam rolling followed by stretching exercise revealed a (2021) reported in their review only a small additional ef- significant but trivial better effect than stretching alone fect when comparing a combined treatment with foam roll- (ES= -0.17; p = 0.04) (see Figure 5). Moreover, further ing and dynamic stretching to dynamic stretching alone. subgroup analyses of the stretching technique (Q = 0.11; p However, the authors did not perform a meta-analysis or = 0.74), the type of foam rolling (Q = 3.21; P = 0.07), and include the static stretching technique, or consider other the type of task (strength, jump height, sprinting) (Q = muscles than the hamstrings. Our meta-analysis included 0.82; p = 0.66) revealed no significant difference in perfor- static stretching and different muscles, but neither showed mance. However, we did not perform a subgroup analysis any superior effect for a combined treatment compared to of the tested muscles since there were subgroups with only stretching alone or foam rolling alone. Figure 4. Forest plot presenting the combined effects compared control condition on range of motion. (Std diff in means = standardized difference in means; CI = confidence interval).
542 Combined effects of foam rolling and stretching Figure 5. Forest plot presenting the combined effects compared to stretching on performance parameters, including a subgroup analysis with the order of the combined treatment (Std diff in means = standardized difference in means; CI = confidence interval; FR= foam rolling). We would have expected that a change in tissue compli- Wilke et al. (2020) reported in a recent meta-analysis that ance (e.g., muscle or tendon stiffness), which has been re- foam rolling and stretching have a similar magnitude of ported following an acute bout of stretching (Kato et al., change on ROM, so that athletes could apply either stretch- 2010; Kay et al., 2015; Konrad et al., 2017), and the addi- ing or foam rolling to increase ROM, according to their tional changes in stretch or pain tolerance following foam preference. However, several studies have reported en- rolling (Nakamura et al., 2021), might have led to greater hanced recovery and reduced delayed-onset muscle sore- gains in ROM compared to stretching or foam rolling ness (DOMS) following foam rolling (MacDonald et al., alone. However, this was not observed in this meta-analy- 2014; Nakamura et al., 2020; Pearcey et al., 2015), but not sis. A possible reason for the lack of an additional effect in following a stretching exercise (Afonso et al., 2021; the combined treatment might be a saturation effect for Henschke 2011). Therefore, if a secondary goal is to reduce ROM, which has also been observed following a certain DOMS, besides the increase in ROM, foam rolling is likely duration of stretching (Mizuno, 2019) and foam rolling the better treatment. (Nakamura et al., 2021). Mizuno (2019) reported a similar With regard to the effects on performance parame- amount of increase in ROM when comparing 10 s of static ters, due to the lack of studies and effect sizes, a compari- stretching with 100 s. Moreover, Nakamura et al. (2021) son was only possible between the combined treatment and reported no further changes in ROM following a single a stretching treatment alone (but not foam rolling or a foam rolling treatment applied for 300 s compared to 90 s. control condition). The meta-analysis revealed no signifi- Hence, if the single treatment of stretching or foam rolling cant changes between the combined treatment and stretch- exceeds a certain duration, no additional changes in ROM ing alone. This is in contrast to the review by Anderson et can be expected. The duration range of the combined treat- al. (2021), who concluded that foam rolling and dynamic ment of the included studies when foam rolling was com- stretching might have a superior effect compared to dy- bined with static stretching was between 40 s and 210 s namic stretching alone. The authors reported that two out (mean: 134.0 ± 77.9 s). Hence, the assumed saturation fol- of four studies found a greater increase in vertical jump lowing a combined treatment for ROM is not unlikely. Ac- height compared to dynamic stretching alone. Moreover, cording to the results of our meta-analysis, it can be recom- two out of three studies included in their review reported a mended that foam rolling (with a duration range between greater effect on agility following a combined treatment 30 s and 120 s; mean 66.0 ± 36.9 s) or stretching (with a (foam rolling and dynamic stretching) compared to dy- duration range between 10 s and 90 s; mean 65.7 ± 28.8 s) namic stretching alone. However, Anderson et al. (2021) could be performed to increase the ROM of a joint acutely, only included studies with dynamic stretching and studies rather than a more time-consuming combined treatment assessing ROM with a sit and reach test. Consequently, This goes in line with previous recommendations on foam several studies that investigated the combined effects on rolling (Behm et al., 2020) or stretching (Behm, 2018). performance parameters with other stretching techniques
Konrad et al. 543 and other muscles were excluded. In the present meta-anal- the country in which they were performed. The authors have no conflict of interest to declare. The datasets generated during and/or analyzed dur- ysis, we analyzed 12 studies in total, including seven stud- ing the current study are not publicly available, but are available from the ies of dynamic stretching and five of static stretching. Sev- corresponding author who was an organizer of the study. eral reviews reported major differences in the effects be- tween static and dynamic stretching if applied prior to a References sports event. Static stretching with a long duration (≥60 s) Afonso, J., Clemente, F. M., Nakamura, F. Y., Morouço, P., Sarmento, likely causes a decrease in performance, while dynamic H., Inman, R. A. and Ramirez-Campillo, R. (2021) The stretching can lead to an increase in performance (Behm et Effectiveness of Post-exercise Stretching in Short-Term and al., 2016; Behm et al., 2021a; Behm and Chaouachi, 2011). Delayed Recovery of Strength, Range of Motion and Delayed A recent meta-analysis of the acute effects of foam rolling Onset Muscle Soreness: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Frontiers in Physiology 12. on performance (Wiewelhove et al., 2019) reported a ten- https://doi.org/10.3389/fphys.2021.677581 dency of improvement (P = 0.06) in sprint performance Amiri-Khorasani, M., Abu Osman, N. A. and Yusof, A. (2011) Acute (+0.7%), but negligible effects on jump or strength perfor- effect of static anddynamic stretching on hip dynamic range of mance. This is in accordance with another review motion during instep kicking in professional soccer players. Journal of Strength and Conditioning Research, 25(6), 1647- (Cheatham et al., 2015) that reported that a single bout of a 1652. https://doi.org/10.1519/JSC.0b013e3181db9f41 foam rolling exercise likely does not induce changes in per- Anderson, B. L., Harter, R. A. and Farnsworth, J. L. (2021) The Acute formance parameters. Therefore, similar to the results of Effects of Foam Rolling and Dynamic Stretching on Athletic Anderson et al. (2021), we expect that a combination of a Performance: A Critically Appraised Topic. Journal of Sport Rehabilitation 30(3), 501-506. https://doi.org/10.1123/JSR.2020- foam rolling and dynamic stretching treatment will likely 0059 lead to a greater increase in performance than dynamic Behm, D. G., Kay, A. D., Trajano, G. S. and Blazevich, A. J. (2021a) stretching alone. However, our subgroup analysis of the Mechanisms underlying performance impairments following different stretching techniques (static stretching, dynamic prolonged static stretching without a comprehensive warm-up. European Journal of Applied Physiology 121, 67-94. stretching) did not reveal a significant effect of the com- https://doi.org/10.1007/s00421-020-04538-8 bined treatment including dynamic stretching compared to Behm, D. G., Alizadeh, S., Anvar, S. H., Drury, B., Granacher, U. and dynamic stretching alone. Hence, according to our meta- Moran, J. (2021b) Non-local Acute Passive Stretching Effects on analysis, dynamic stretching alone can lead to a similar per- Range of Motion in Healthy Adults: A Systematic Review with Meta-analysis. Sports Medicine 51, 945-959. formance changes as the combined treatment. Therefore, https://doi.org/10.1007/s40279-020-01422-5 foam rolling does not necessarily have to be included if the Behm, D. G., Alizadeh, S., Hadjizadeh Anvar, S., Mahmoud, M. M. I., goal is to increase performance. Similar to the results for Ramsay, E., Hanlon, C. and Cheatham, S. (2020) Foam Rolling the dynamic stretching group, no difference between the Prescription: A Clinical Commentary. Journal of Strength and Conditioning Research 34, 3301-3308. combined treatment and the static stretching treatment https://doi.org/10.1519/JSC.0000000000003765 alone was shown by the meta-analysis. Behm, D. G., Blazevich, A. J., Kay, A. D. and McHugh, M. (2016) Acute Further subgroup analyses showed no significant effects of muscle stretching on physical performance, range of differences between the different muscles tested (e.g., motion, and injury incidence in healthy active individuals: a systematic review. Applied Physiology, Nutrition, and quadriceps, hamstrings), the type of foam rolling (vibration Metabolism 41(1), 1-11. foam rolling, non-vibration foam rolling), or the type of https://doi.org/10.1139/apnm-2015-0235 task (e.g., strength, power). However, a significant differ- Behm, D. G. and Chaouachi, A. (2011) A review of the acute effects of ence could be detected between the orders of the combined static and dynamic stretching on performance. European Journal of Applied Physiology 111(11), 2633-2651. treatment. Stretching followed by foam rolling showed a https://doi.org/10.1007/s00421-011-1879-2 similar magnitude of change on performance as stretching Behm, D. G. (2018) Recommendations for stretching prescription. In The alone; however, the foam rolling followed by stretching ex- Science and Physiology of Flexibility and Stretching. Routledge. ercise revealed a significantly but trivial better effect than https://doi.org/10.4324/9781315110745-6 Borenstein, M., Hedges, L. V, Higgins, J. P. T. and Rothstein, H. R. stretching alone (see Figure 5). A possible mechanism for (2009) Introduction to Meta-Analysis. why foam rolling before stretching can lead to a favorable https://doi.org/10.1002/9780470743386 effect compared to stretching alone is unclear and should Che Hsiu, C., Chiu, C.H., Tseng, W.C., Ye, X., Chen, C.H., Wu, C.Y. and be investigated in future studies. Chang, C.K. (2021) Acute Effects of Combining Dynamic Stretching and Vibration Foam Rolling Warm-up on Lower-Limb Muscle Performance and Functions in Female Handball Players. Conclusion The Journal of Strength and Conditioning Research. https://doi.org/10.1519/JSC.0000000000003998 It can be concluded that athletes under time constraints do Cheatham, S. W., Kolber, M. J., Cain, M. and Lee, M. (2015) The effects of self‐myofascial release using a foam roll or roller massager on not have to combine stretching with foam rolling in order joint range of motion, muscle recovery, and performance: a to increase their ROM because the combination does not systematic review. International Journal of Sports Physical lead to any additional effects. However, if the goal is to Therapy 10(6), 827-838. also increase performance (e.g., strength, speed), the com- Cunha, J. C. O. M. de, Monteiro, E. R., Fiuza, A., Neto, V. G. C., Araujo, G. S., Telles, L. G. S. and Novaes, J. S. (2021) Acute Effect of bination of foam rolling followed by stretching (but not Foam Rolling Before Dynamic Stretching on the Active Hip vice versa) should be favored compared to stretching alone. Flexion Range-of-Motion in Healthy Subjects. Journal of Exercise Physiology Online 24(2), 81-90. Acknowledgements Fairall, R. R., Cabell, L., Boergers, R. J. and Battaglia, F. (2017) Acute This study was supported by a grant (Project J 4484) from the Austrian effects of self-myofascial release and stretching in overhead Science Fund (FWF). The experiments comply with the current laws of athletes with GIRD. Journal of Bodywork and Movement
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Konrad et al. 545 AUTHOR BIOGRAPHY Key points Andreas KONRAD Employment This is the first meta-analysis to have compared the Institute of Human Movement Science, combined effects of foam rolling and stretching with Sport and Health, University of Graz the effects of stretching or foam rolling alone. Degree PhD, MSc, BSc The meta-analysis revealed a significant overall ef- Research interests fect on ROM of the combined treatment when com- Biomechanics, muscle performance, pared to no intervention. training science, muscle-tendon-unit, The results showed no favorable effect on ROM or soccer science performance when compared to the effect of stretch- E-mail: andreas.konrad@uni-graz.at ing or foam rolling alone. Masatoshi NAKAMURA The subgroup analysis revealed that, if the goal is to Employment Lecture, Institute for Human Movement increase performance, the combination of foam roll- and Medical Sciences, Niigata University ing followed by stretching (but not vice versa) of Health and Welfare, Niigata, Niigata, should be favored compared to stretching alone. Japan Degree PhD Research interests Physical therapy, stretching, exercise physiology, flexibility E-mail: masatoshi-nakamura@nuhw.ac.jp Daniel BERNSTEINER Employment Institute of Human Movement Science, Sport and Health, University of Graz Degree BSc Research interests Training science, biomechanics E-mail: daniel.bernsteiner@edu.uni-graz.at Markus TILP Employment Institute of Human Movement Science, Sport and Health, University of Graz Degree PhD Research interests Biomechanics, training science, muscle- tendon-unit, sports game analysis E-mail: markus.tilp@uni-graz.at Mag. Dr. Andreas Konrad, BSc MSc Institute of Human Movement Science, Sport and Health, Univer- sity of Graz, Mozartgasse 14, A-8010 Graz, Austria
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